Provider Demographics
NPI:1083972822
Name:MBAH, JENET ENGONWEI
Entity Type:Individual
Prefix:
First Name:JENET
Middle Name:ENGONWEI
Last Name:MBAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3267 QUEENSTOWN DR
Mailing Address - Street 2:301
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1080
Mailing Address - Country:US
Mailing Address - Phone:240-476-1036
Mailing Address - Fax:
Practice Address - Street 1:3267 QUEENSTOWN DR
Practice Address - Street 2:301
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1080
Practice Address - Country:US
Practice Address - Phone:240-476-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide